Appointment Request Form Please fill in the form below to setup an appointment.Name* First Last Preferred Location*Please selectRainierMadisonPatient Type* New patient Returning patient Reason for Appointment* General Eye Exam General Eye Exam with Contact Lens Fitting (I have never worn contact lenses before.) General Eye Exam with Contact Lens Fitting (I have worn/am currently wearing contact lenses.) Other Other Reason for AppointmentPreferred Time Morning Afternoon Anytime Preferred Day/s Monday Tuesday Wednesday Thursday Friday Saturday Preferred Method of Communication* Email Phone Call Email and Phone Call Insurance Premera VSP Medicaid Other If other, please specify Phone*Email* CommentsCAPTCHAEmailThis field is for validation purposes and should be left unchanged.
